Provider Demographics
NPI:1134452394
Name:ROY, ANGELA L (PA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:ROY
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:C
Other - Last Name:ANGELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36139 WESTIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734-3437
Mailing Address - Country:US
Mailing Address - Phone:225-237-1810
Mailing Address - Fax:225-763-4117
Practice Address - Street 1:8585 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3748
Practice Address - Country:US
Practice Address - Phone:225-237-1810
Practice Address - Fax:225-763-4117
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA200271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03053256Medicaid
LA1894125Medicaid
LA275380YH3VMedicare PIN
LA275380YJA2Medicare PIN
LA1894125Medicaid